Prostate Health and Hair Loss Interventions

Welcome to Huberan Lav Essentials, where we revisit past episodes for the most potent and actionable science based tools for mental health, physical health, and performance Hi'm Andrew Huberan, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. And now for my discussion with Dror Kyle Gillette Dr. Gillette, great to have you back Great to be back. Thank you. I'd like to begin with a question about what all males ought to do in order to optimize their hormones What should they be doing? What should they avoid doing if the goal is to have a long arc of healthy hormone optimization throughout the lifespan? There's many things that you should do. An analogy that I often make is when there's a brand new car that comes off the assembly line, you do a full scope of diagnostic workup, hook it up to the computer And I think we should do the same thing with humans as well Dear in puberty You know, obviously you're a functioning human, but I would say there's still development. And I think that the human always develops. I don't think development ever ends. But you want to monitor that progress across a person's lifespan. What do you think are the key things to look for in blood work? I mean, testosterone is always the topic that comes up in the context of male hormone optimization, but certainly there are a lot of other hormones that are important as well And with testosterone, you want to get either testosterone in an SHBG or a free testosterone Could you define SHPG for our listeners, please? It is sex hormone binding globulin. It is the protein that binds up. All androgens and estrogens in the body So the stronger the androgen, the stronger it binds. Dering puberty strrong androgens, especially DHT, which is the strongest bioidentical androgen has a huge role, a prominent role in secondary sexual characteristics And if your SHBG is very high, then your DHT can run higher because it's not metabolized but there's not quite as much free DHD. So you want to balance between high enough free DHT and a high enough total DHD. So assuming that there's no major intervention How often do you recommend that people get their blood work done using shared decision making with their physician Usually a good follow up is about six months. So on a daily basis, maybe you could just take us through the arc of a day and push out some of the protocols that you use or the things that you'd like to see your male patients use in order to try and optimize their hormone status. I'll briefly touch on some of the lifestyle pillars to start diet and exercise are the first two In puberty, sleep is particularly important, of course But with diet and exercise throughout A lifespan, you want to not exclude things that are helping you. For example, during puberty, if you're consuming dairy and then all of a sudden you cut out all dairy, dairy can help increase IGF one and free IGF one. And just for our audience, mayaybe you just mentioned what having enough IGF one can do for us that's beneficial is it helps you grow, it helps with genital development, secondary sexual characteristics and long bone growth. skin growth, hair growth, a host of things. So getting an array of nutrients that include dairy, what other sorts of nutrients are important during development. You want to have adequate vitamin D. Vitamin D helps with testosterone production. It helps again with bone mineralization and stature after an age of about twenty five, and there's not a strict cutoff Up to about age of twenty five, optimizing your growth hormone in IGF one helps with bone density and bone growth So from the dietary standpoint, you want to have enough free estrogen, not too much when you're growing, but You want to help basically stockpile bone to prevent a risk of osteoporosis or thin bones fractures when you're older. I realize that some of this relates to ethics and food allergies and things of that sort. but would you say that on balance that most people would benefit from eating a combination of quality proteins from animal sources and non animal sources, fruits, vegetables, and starches. I mean, what do you think, for instance about people following a pure carnivore or a very pure vegan diet in their twenties and thirties In their late twenties, it might be a reasonable option. In early twenties and certainly teens, it is a horrible idea because it is likely to significantly decrease your free androgens, so you will have less testosterone acting on receptors through the body Are there any other micronutrients or macronutrients that people in their twenties and thirties should emphasize? Fiber is going to be paramount in kind of like setting your set point of your gut microbiome the rest of your life. There is prebiotic fiber, which you could think of as fish food for your good gut microbiome, your gut microbiome iss kind of like an aquarium or a fish tank. Any fiber or food that you're putting in your gut. It's either going to it's going to skew your gut microbiome towards something that is more beneficial or more detrimental. And would you say that the prebiotic fiber and the getting essential fatty acids be important to do throughout the lifespan or just for the people in their twenties Thout the lifespan, particularly important in the teenage, twenties, thirties because it helps with brain development. You're certainly more of an expert than me when it comes to brain development, but it does continue to develop really throughout the lifespan, but certainly through the twenties and thirties as well. In a previous discussion of ours, I asked you about caloric restriction and testosterone. And if I recall correctly, the idea was that if somebody is overweight, they have excess fat adipose tissue then getting rid of some of that adipose tissue through caloric restriction and exercise, provided it's done not too fast in a healthy way. is going to be beneficial for testosterone in the long run For individuals who are not carrying an excess of body fat, caloric restriction is actually going to lower testosterone First of all So I have that correct. and second, are there any addendums to that that you'd like to give us now That's correct. If you look at individual in a caloric deficit, several changes will happen. One is that they'll have less building blocks for hormones Another is that they will be in a catabolic state more often, so that balance of anabolism and catabolism will be different They'll likely have less signaling from Gth hormone and IGF one. And they'll also have the high SHBG that we defined earlier as the binding protein. so they' free androgens and free estrogens will go down Now what are some of the other pillars of creating the proper environment for hormone optimization? Stress is probably the next one. Daring U puberty, but also the twenties and thirties Individuals are up figuring out how they want to cope with stress and also figuring out what they want to choose to put their effort into. So if someone is overstressed, then they can have it can all the other lifestyle pillars and then they stop dieting well, they stop exercising and everything else can go askew. What would be some of the additional things that everybody should do? Another one is finding what your purpose is in life So I call this spirit, but it's really just the self actualization component of Maslow's hierarchy of needs, which is basically your physical needs, your mental needs, and then your purpose in life, what you really like to do. The idea is not to pick the end goal, it's to pick a goal and then once you reach that goal to assess and then pick another goal and so on. I think sometimes when people hear about picking a purpose, they're like, oh my goodness, I have to define sort of like naming oneself that you actually can change your goals and purpose over time I'd like to take a quick break and acknowledge one of our sponsors, Element. Element is an electrolyte drink that has everything you need and nothing you don't. That means the electrolytes, sodium, magnesium, and potassium in the correct amounts, but no sugar. Proper hydration is critical for optimal brain and body function Even a slight degree of dehydration can diminish cognitive and physical performance. It's also important that you get adequate electrolytes. 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I hate to say that I love one more than all the others, but this lemonade flavor is right up there with my favorite other one, which is raspberry or watermelon. Again, I can't pick just one flavor, I love them all. If you'd like to try element, you can go to drink element. com slash Hubberman, spelled drinklmNT d. com slash Hubberan to claim a free element sample pack with a purchase of any element drink mix. Again, that's drink element d. com slash Hubberman to claim a free sample pack I'd like to return to the key things that people should do, or I should say, the key things that men should do to optimize their hormones. What do you think is a healthy sustainable exercise regimen that anyone can follow that will also support their hormone status For really vigorous exercise around three to four times a week is very sustainable over a long period of time On top of that, you could add in three or four more instances of less vigorous exercise. When they study the effect of exercise, specifically vigorous exercise One area that's been studied is vigorous exercise episodes lasting longer than an hour And they usually track it by a rating of perceived exertion, which isn't perfect and it's not extremely actionable, but it's helpful for clinical science. But the takeaway from that is basically do not it is not hormonally helpful. to train, especially regularly trained vigorously for longer than an hour these days For better, for worse. I think for worse Younger guys are asking about and using testosterone replacement therapy, so called TRT No world Would any male in his teens or twenties or even thirties whose blood levels of testosterone and estrogen are at the appropriate levels, mean within the normal reference range. why would they takeake exogenous destosterone Given all the negative effects on fertility someome of the challenges that it can present if the dosages aren't quite right, et cetera. Why would they do that? certainly if they are not being paid for a particular endeavor, likeike they're not making money. If they are playing a sport chances are they're not allowed to do that anyway. It it' on the banned sububstances list To me, it just seems like a crazy idea Um But then again, I'm of a generation that really hasn't thought about doing that stuff until people were in their forties and fifties or even never Is there ever a case for somebody in their twenties or thirties to take testosterone if their blood levels are within the three hundred to nine hundred Nanograms per deceliter reference range. You know, everyone has their different reason As far as like, When does the benefit outweigh the detriment notot very often if you're in your twenties and certainly Trouble Almost hardly never. There's always, you know, rare cases like Cleman syyndrome and whatnot Almost never if you were very young. Okay, so for people in their twenties, thirties and beyond, forties, et cetera who is Testosterone and estrogen levels are at the appropriate ratios and in within the normal reference range. Lbido energy, recovery, et cetera are feeling you know at least workable for their lifestyle For those people What can they do besides get great sleep train not too hard or too often, et cetera, etera. What are some of the things in the realm of supplementation that can help them optimize their testosterone and estrogen without suppressing their own endogenous production of testosterone and estrogen Let's mention creatine is the first one Freatine is interesting because it has multiple different effects. It helps with amino acid synthesis It also helps with oxidative stress It can also serve as the backup fuel tank for your mitochondria. So kind of holding backup ATP And it does slightly increase total testosterone and it also increases the conversion of testosterone to dihydro testosterone. So potentially it's especially useful in men in their even their teenage years and their twenties You mentioned the conversion of testosterone to dihydrogestosterone and there is mythology out there that creatine can increase hair loss. I'm guessing because There's at least one study showing that creatine can increase DHD. Dihydrogestosterone and DHD is one of the primary hormones that can promote male pattern baldness So the Question, therefore, is, does creatine supplementation increase the rate of hair loss. each individual Preventing hair loss is a very poor reason to take creatine because it's not going to take you to a supra physiologic level It's not going to you know, increase your androgens to an unnormal level of binding So I feel like If that was a reason to not take creatine for hair loss, then for sorry, you mean hair loss is not a reason to avoid taking creatine. cororrect. hair loss is not a reason to avoid taking creatine. Think of it as just bringing you to what you are naturally inclined to have. If your conversion of testosterone to DHD is already high Then often creatine does not affect this It just kind of resets your balance between testosterone being aromatized to estrogen or being five alpha reduced DHT. So it's not going to speed up hair loss more than just Naturally being a male does. So in some individuals, it will have no effect. In some individuals, for whatever reason, they have almost no five alpha ad ductase activity, it will return them to natural or normal. So what other supplement based tools can people consider Another one we can loop in with creatine is betaine. Some people are non responders to creatine. you can increase that to ten grams orr you can use its cousin, betetaine to help with amino acid synthesis and shunting of energy Along with that, I would put L cararnotine. Beta In, do you recall dosage people typically would take if they're a creatine non responder. One to three grams. In Yeah. Several versions of creatine have betaine mixed in. because it helps with the processing of methionine and homocysteine So if somebody is already taking creatine and likes it and responds to it raise my hand, such as myself adding betaine help or is it redundant with creatine? Only if their homocysteine is persistently elevated. And homocycysteine is kind of like an inflammatory marker that can build up if you're not converting enough of it down thestream would I know J just a blood test. So Lcarnotine, what are the ways to take Lcarnitine? I know that there's an oral form so capsules and there's injectables. The injectables, I think you need a prescription, Is that right Correct, you need a prescription for the injectables or you should really get a prescription for the injectables When you inject it, of course, at the supervision of your doctor, it's usually done intramuscularly. It's an aqueous solution. So it does not have like an oil or a carrier oil in it like TR like testosterone esters do. However, if you inject it too superficially, it's not going to make a raak anything. Oftten it just burns if you inject it subcutaneously and it is not disseminate throughout the body as well L cararnotine potentially has localized effects if you inject it If you ingest it orally, then it has a very low bioavailability, maybe only ten percent So what are the doses of Lcantine that one needs to ingest then if they want to get a benefit because only ten percent is being absorbed It's probably a lot of Llcarnine. How much should people take per day Usually I recommend for oral Lcarnatine between one thousand milligrams and up to four or five thousand milligrams. So one to four, maybe even five grams. correct. Okay. Up to five grams a day. If you're on that much, especially if you have a dysregulated gut microbiome You should be concerned with TMAO, which is a potential carcinogen that both carnotine and choline can convert into and your gut microbiota determine How much that happens? Is it true that I can offset any negative effects of alpha GPC choline, that is Nlcarnotine that I take by ingesting garlic? Is that right? There's a compound in garlic called Allicin. I believe it's A L L I C IN. It's also part of the scientific name, the genus of types of garlic This can help decrease the conversion to TMAO. Berberne actually slightly decreases the conversion to TMAO as well probably through alteration of the gut microbiome and then just optimizing your gut microbiome can decrease conversion. So not everyone needs Allisin But it's something that you should certainly consider if you were on a high dose I'm going to continue to take the six hundred milligrams of garlic every time I take my allkarnine, but I'm going to skip the berberine because berberine gives me brutal headaches and it makes me crave of carbohydrates because it drops my blood sugar. It has many other effects, including the Daon phenomenon where it drops your blood sugar when you're sleeping and you can't even realize it. Okay and what we did not talk about is what L Carnitine does It's a shuttle. So I think it's named carnotine palmatel coenzyme A. Basically it just takes nutrients from outside your mitochondria and puts them in. It also has a unique effect, well, not too unique because Tadalail actually has this effect as well is that it increases the density of the androgen receptor and the cytoplasm of your cells So even if your androgen receptor sensitivity doesn't change and even if your testosterone does not change you will have more testosterone binding to that increased number of receptors. Does one need to cycle L carnacine, creatine, betaine No reason to cycle any of those. What other supplements can one use to try and improve hormone profiles. And And here I realize we're using a very broad brush because when we say improve hormone profiles, what are we really talking about? For me at least I think about the subjective You, do people feel like they are going to have more energy as a consequence of doing these things? Are they going to have the more optimized libido? Are they going to have more optimized recovery from exercise? right? Because I mean, it's not clear to me that taking one's testosterone from six hundred to eight hundred is always going to be a good thing, especially if estrogen is increasing in parallel cause issues, it could Certainly make things better. it could certainly make things worse, right? Let's briefly mention vitamin D, which is also a hormone. It's actually a sterile hormone. and have if you have deficient vitamin D and you replace it, then you will optimize your testosterone It's also mentioned boron. So if you have a very high SHBG, boron can acutely help lower it, usually in a dose of five to twelve milligrams per day It's not really a sustained effect Boron is depleted in soils in many countries. I believe it's very high in soils in Greece and Turkey. So eating dates or raisins that are from those areas potentially have more boron Boron also might be one of the reasons why the reference range for testosterone is much higher in those countries. than other countries. And just to remind people that SHPG sex hormone bining globulin is attaching to the testosterone molecule and limiting the amount of so called free testosterone that's available to have its impact on cells. Okay, so vitamin D three, I'm guessing you're talking about vitamin D three specifically, when you say vitamin D. And then boron five to twelve milligrams per day And then what are some of the other things to optimize testosterone that are in supplement form? We could talk about things that affect this Dotogenesis cascade. so we could touch on Tong Kad Ali. I know we've talked about that a little bit before. But I'm guessing a number of people probably haven't heard that conversation Also known as Ljack And that up regulates several different enzymes in the steridogenesis cascade And by that, what you mean if, and this is another good thing to Google. I think anybody interested in hormone optimization should understand where sterol hormones come from. they come usually from cholesterol they can be shunted off to vitamin D very easily. They can be shunted off to testosterone or estrogens or progestogens quite easily as well. But Tong Cat helps with the conversion of multiple key steps where you synthesize testosterone. Another I think if it as like a coenzyme, a cofactor, an up reggulator of these steps is insulin and IGF one So a good rule of thumb is if you are not expecting as much growth hormone, insulin and IGF one For example, lower carb diets caloric deficits. You're trying to cut body fat or body weight. then Tongkat is going to be theoretically, especially powerful What sorts of dosages of Tongut do you recommend to your patients Anywhere from three hundred to twelve hundred milligrams a day. With Tongcat, you need to be careful with the standardization. becausecause and if you're thinking about a general Tong Cat supplement, which is by far the most well studied then you're looking at the uricominone content, which is a plant compound that is likely the main active pharmacologic effect. so that's compound that's having the effect on the body. And if you standardize the uuric chominone very, very high then theoretically you're having more effect at a lower dose. My blood work tells me that it causes an increase in free testosterone for me and also a slight increase in lutinizing hormone for me. What are some of the other effects on various hormones that you've observed in the blood work of your patients taking Tonga Ali? Tonguecaat can also slightly increase DHEA and If you have a very high SHBG, again, that's the protein that binds up your androgens and estrogens, an extremely important protein The higher your SHBG, the more it helps decrease it So they've studied Tong Cat in populations with very normal SHBGs and it does nothing for SHBGs. Interesting. Does that mean it does nothing for somebody overall? So if somebody has SHBG that's in the normal range, will taking Tongga benefit them in any other way Yes It'll increase their total and free testosterone I'd like to take a quick break and acknowledge our sponsor, AG Wan AG one is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens I discovered AG one way back in twenty twelve long before I ever had a podcast, and I've been taking it every day since. 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If you would like to try AG one, you can go to drinkagG one d. com slash Hubberman to get a special offer For a limited time, AG one is giving away a free bottle of their new omega three coenzme Q ten product Omega three and cooenzyme Q ten are known to support cardiovascular health cellular health and energy generally, brain health and much more I personally take them both every day Again, go to drinkagG one dot com slash Hubberman to get a free bottle of the new Omega three cooenzym Q ten with your first AG one subscription what are some of the other hormones that you prescribbe to your patients who do not want to go on testosterone replacement therapy take exogenSDHEA or anything like that We could talk about phhadosjia next. Phadoosia is interesting because it's a genus of plants, Phadosjia, Agrestis is one of them. There's many others that are very interesting That species is likely the most well studied and it will increase LH amazing. I would not consider it an LH mimetic, so it doesn't really mimic it but it increases the release of lutenizing a hormone from the pituitary. That's a hormone that binds to the late ex cl to the LH receptor kind of like HCG does and it will increase the release of testosterone. What dosages do you have patients take? I've heard of some potential toxicity to the testicular cells. There is one study and this is a rat study, but you can equate the dose of toxicity in rats and humans. they did not give these rats any antioxidants increases a couple different pro inflammatory markers. One is GGT or gamma gllutamal transferase comes from both the testes and the liver, and one is alkyl and phosphatase. alsoso known as alkphos Again, coming from both areas There are several different ways that you can attenuate this increase, and you can also just check to see if you have increased. in the rat dose that equates with humans that had no effect, so the safe dose was an average of three hundred milligrams a day. So that would be three hundred milligrams a day in humans is the dosage that did not have toxicity. cororrect? Correct. And often even if there is toxicity in rats, there is not toxestin any humans. So it's not directly equitable. but to be safe Another regimen that I have people take is six hundred milligrams every other day or six hundred milligrams three times a week. offtten Monday, Wednesday, Friday My understanding is that nowadays a lot of people are using testosterone. let's not even call it replacement therapy because some of these people have six hundred, seven hundred or even You know, eight hundred nanogram per deceliter read. So they're not replacing anything that is diminished. They're just trying to augment what's already there, increase what's already there My understanding is that Taking a low dose more frequently is going to be more beneficial than the kind of old school way of giving, you know one hundred or even two hundred milligrams in a single injection once every two weeks. Is that right? And what do you do with your patients? So let me give you a hypothetical. Somebody comes in your office Um do their blood work and they have Um blood levels of Let's say six hundred nanograms per decilyer testosterone, their estrogen is also in normal range Everything else checks out But they're complaining of, you know, slightly diminished libido, slightly poor recovery from workouts, maybe, you know reduce motivation and drive, although no major depression. and you come to the conclusion that testosterone therapy Not replacement but testosterone therapy might be a good option to explore. What's a typical dosage range and frequency of administration range that you might consider exploring And some of this depends on the SHBG and free testosterone as well. So if that same individual had a very high SHBG, which again, is the binding protein that binds up the testosterone and all androgens and estrogens If it is extremely high and they have a free testosterone of two then they might need a different dose because they need enough testosterone in order to have a Normal Hughanaddle free testosterone But a general normal dosing range, especially for someone starting is around one hundred to one hundred and twenty milligrams divided over the course of a week. usually either every other day or three times a week, occasionally twice a week. Many people with SHBG a bit higher can get away pretty easily with twice a week This is assuming that the ester is cpiianate or ananthate. So two sixty milligram injections of toser and ccipiate per week Very common dosing too hit that one hundred and twenty milligrams per week as kind of the typical average correct. And I would consider this like a physiologic euggan adult dose For many people, even two hundred milligrams a week is far above the reference range. All of this is said with the caveat that testosterone is normally released in a pulsatile manner. So it's high in the morning, low in the evening Whereas if you're on testosterone therapy then you're going to have a steady state. so your testosterone level is going to be prettyretty much the same even in the evening In your experience, when patients do that, I'm guessing they report the normal constellation of positive effects, you know, improved mood, improved energy, improved sleep, recovery, et cetera. What are some of the hazards or things that can crop up in bloodw or just subjectively that can be warning signs that even a dosage of one hundred twenty milligrams divided into these two or three dosages per week is too high? So this is when you really have to be at least well versed in every organ system, not just the ganadal genital system you have , you know, Dermatology, prowess. acne is a very common change. Lots of different skin pathologies or even bruising can be related to hormone replacement Hair loss is very common to see as well mental status changes, it could occasionally it even induces a manic or a bipolar episode because testosterone is also dopamergic. And then cardiovascularly, not just in the heart, but also concerns for like microvascular ischemic disease Ferritin buildup because the estrogen also increases And then fertility concerns as well and lipid concerns too. So you really have to be, you know, hematologist, dermatologist cardiologist Lidologist the whole nine yards So another reason or set of reasons rather to if one is considering using testosterone therapy to really do this in close communication with a really good physician ' that's a lot to monitor. Kning whether or not you have acne or not is one thing But knowing whether or not your LDL is going up, your AOB is going up, That's a whole other business and that needs to be done through bloodwk is what I'm hearing Correct. And if your physician that is managing or prescribing your testosterone therapy or your HRT, is not well versed in these systems, you would want him or her to be part of an interdisciplinary team where they have other experts that can monitor those systems there are males out there who want to increase their testosterone and other hormones may be thorm, et ceter. opt to not take Exogenous testosterone. So no cream, no pellet, no No pill no injectable sacipienate decide to take chlomophin a couple of times a week My understanding, I've never done this, I would say if I had. My understanding is that Taking Chlomopin to fifty milligram Tablets a week is what I hear people are doing. will increase what Lutinizing hormone Various estrogen receptor subunits, could you explain how chlomophyen would benefit anyone? And is this a good strategy? I'm hearing that it's being done quite a lot now It will increase testosterone in a dose dependent manner but it has many other pharmacodynamic effects, which is the effect of the drug on the body. other than its effect on the hypothalamus and the pituitary. So in the hypothalamus and the pituitary It does what's called negative feedback inhibition or it It blocks the oxygen of estrogen. So it crowds out estrogen from the estrogen receptor on the hypothalamus in the pituitary. Why would I want to take something that would increase the activity of an estrogen receptor I just can't find the rationale for that. The main rationale behind taking a SM is as a very temporary measure that is not going to suppress pituitary or hypothalleamic function If your testosterone is just so drastically low that it is unlikely to recover any anyway So most of the time, it is not clinically useful and SEM should not be prescribed very often, certainly not as long term testosterone replacement or testosterone optimization in most individuals. There's always exceptions to everything There's five different estrogen and estrogen related receptors There's two main estrogen receptors in Clomid and every SM has a very unique profile because they selectively inhibit some receptors in some tissues, but not other receptors in other tissues. For example, Clomid can inhibit receptors that are in the eye and it can cause Visual changes blurry vision. especially at higher doses It also acts in every other tissue of the body. So side effects from Chlomid and other selective estrogen receptor modifiers are very common. 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Every two weeks The other thing to keep in mind with alcohol is it has a lot of calories, seven kilocalories per gram, almost as much as fat, which is nine And then it's also very GABAergic. so it can activate inhibitory neurotransmission. and that can also affect how many how much LH and FSH is released So that can also decrease testosterone, almost kind of similar to how opiates can decrease testosterone want to go back to the prostate and talk to you about something that's kind of a newer emerging trend. I know that you've talked a little bit about this in previous podcasts A number of men, I should say a number of physicians are prescribing low dose tedalophyil, also known as Cialis to their male patients. so in dosage ranges of like two point five milligrams to five milligrams per day, but not for erectile dysfunction, but rather for improving prostate health And presumably they get sort of a boost in terms of blood flow to the genitalia as well. But again, not specifically a deal with erectile dysfunction, but to deal with prostate health and blood flow to the prostate. Is that something that you sometimes often prescribe to your patients and of what age? If LoFL is a very underrated medication, the age would kind of depend on the indication So Tedalophil is also a blood pressure medication. It can very slightly decrease blood pressure, especially at higher doses At higher doses at the a high dose would be twenty milligrams, not two point five milligrams But consistently, it can somewhat affect with the cones in the eye that have to do with red and green sight. Although if you remove it, that effect is reversed. So basically, if you don't need really, really good red, green discrimination, you can take higher doses But in general, I recommend no higher than ten milligrams a day, usually just two or five milligrams One other benefit or other use of Tadalophyll is that it increases the density of the androgen receptor similarly to L carnetine So that's an interesting benefit. An The benefit is that if you give it to people with noacteria, which is urinating at night in general, it will cut the episodes in half. So it could go from two to one which can make a big difference for your sleep, which will secondarily make a big difference for your growth hormone and testosterone optimization Interesting. So you said two point five to five milligrams per day is kind of typical for these prostate enhancing effects. Yes I get a lot of questions about drugs to offset hair loss. Most of those drugs are going to operate through the DHT system, the diydrogestosterone system, for the reasons we talked about before, DHT receptors being on the scalp growth on the face, Is it the case that a number of people taking things like Ppecia and other things to block the DHT or disrupt the DHT pathway are going to experience diminished seex drive diminished. kind of motivation and general vigor. And if so, are there alternatives like topical DHT antagonists that they might use if they want to keep their hair? but not have those negative effects Many people that have just a bit of predisposition, they can use things that are topical antiandrogens Ketochonizol is one of them. caaffeine is actually another one. Wait, you have to explain how this works. How do people get caffeine into the hair all? Topically, the caffeine enters the scalp and crowds out like somewhat crowds out the Androgen. and it is a weak effect It's likely just strong enough to be clinically significant. Usually caffeine is put into formulations with other things like ketochonizol that are also weak anti androgens O notes spperonylactone can be prescribed topically, but it is absorbed systemically because the size of the molecule So unless your doctor specifically prescribes that for you, especially as a male, do not use topical spirontylactone le finastteride is also a smaller molecule So it is also systemically absorbed But it is not extxtremely well systemically absorbed. If you take topical finasteride, then usually your systemic DHT will decrease by about thirty percent topical dutasteride is likely a tiny bit stically absorbed, but it's unique because it's half life is much faster at a lower dose So topical dutaseeride will not affect your systemic DHD at all. And I've seen this anecdotally on many people on topical dutesteride therapy On behalf of the audience and just for myself, thank you so much. You have an immense amount of knowledge and you're exquisitely good at sharing it with people in an actionable way. So thank you. My pleasure